Textbook Misogyny

by Michael Greger, MD and United Progressive
Alumni

A survey of contemporary obstetrics/gynecology textbooks showed
a, "bias toward greater concern with the patient's husband than the
patient herself." An example from J.R. Wilson's well known, widely used Obstetrics
and Gynecology: "The traits that compose the core of the [female]
personality are feminine narcissism, masochism, and passivity."[596] Listed in an accompanying table entitled "Components
of a mature feminine personality" are such traits as, "allows male to
conquer" and "sacrifices own personality to build up that of
husband."[597]

The still used Medical, Surgical and Gynecological
Complications of Pregnancy describes assertive women as
"dangerous."

Those patients who consider themselves 'socially aware'... are
not necessarily more mature but are trying, by their active interest in
everything 'avant garde,' socially as well as medically, to persuade themselves
and others that they are.... This is the patient who is interested in such
methods as 'natural childbirth,' hypnosis, or using childbirth as an
'experience.'

The intensity of the demands of the occasional woman who is
fanatic in her zeal for 'natural childbirth'... and her uncompromising attitude
on the subject are danger signals, frequently indicating severe psychopathology....
A patient of this sort is not a candidate for natural childbirth, and requires
close and constant psychiatric support.[598]

For the female is, as it
were, a mutilated male - Aristotle

From an article on gender bias in anatomy textbooks:

In standard human anatomy illustrations, males are practically
the only subjects. That the male is depicted as the standard human body recalls
the long period during the development of medical science when men were
considered the only worthy patients of doctors and when the business of caring
for the less valued female bodies were left to laypersons such as midwives or
women neighbors.[599]

Findings from a Social Science and Medicine study of all
anatomy texts currently in use in a major western medical school:

In illustrations, vocabulary and syntax, [the 31 studied
anatomy] texts primarily depict male anatomy as the norm or standard against
which female structures are compared. Modern texts thus continue long-standing
historical conventions in which male anatomy provides the basic model for the
'human body.'

In text sections dealing with standard (non-gender-specific)
anatomy, male subjects [were shown over five times more frequently in]...
illustrations in which gender was discernible. In the century from 1890-1989, [U.S.] anatomy
texts have remained consistent in the disproportionate use of male figures or
male-specific structures to illustrate and to describe human anatomy. Female
bodies are primarily presented as variations on the male.[600]

Feminist Gremlin

As reported in John Robbins' Reclaiming our Health, "The
standard obstetrical textbook in use today is William's Obstetrics. The
15th edition of this classic is 923 pages long.... Apparently a feminist
gremlin was at work during the boring task of preparing the index."[601]

In the index there appears an entry that was apparently slipped
in unnoticed by some brave soul who... wanted to voice his or her opinion about
the book. The line reads: 'Chauvinism, male, variable amounts, pages 1-923.'
The 16th edition of this illustrious text was a bit longer than previous
editions, and the heading in the index was adjusted accordingly: 'Chauvinism,
male, voluminous amounts pages 1-1102.'[602]

Physicians Know As Much About Sex As They Do About Nutrition

As reported in Our Bodies, Ourselves, one obstetrics text
describes female orgasm as, "not at all contingent on mechanical and
muscular stimuli but rather on how a woman feels about her husband." The
author-doctor goes on to say that the only important question to ask a woman with
regard to her lack of sexual satisfaction is, "Does she really love her
husband?"[603]

Principles of Gynecology (1967):

An important feature of sex desire in the man is the urge to
dominate the woman and subjugate her to his will; in the woman acquiescence to
the masterful takes a high place.

Novack's Textbook of Gynecology (1970):

The frequency of intercourse depends entirely on the male sex
drive.... The bride should be advised to allow her husband's sex drive to set
their pace and she should attempt to gear hers satisfactorily to his. If she
finds after several months or years that this is not possible, she is advised
to consult her physician as soon as she realizes there is a real problem. In
assuming the role of 'follow the leader,' however, she is cautioned not to make
her sexual relations completely passive. Certain overt advances are attractive
and provocative and active participation in the sex act is necessary for full
fruition. She may be reminded that it is unsatisfactory to take atone-deaf individual
to a concert.

Gynecologist John M. Smith, in his book Women and Doctors,
writes, "I have seen more than one gynecologist walk into an operating
room where another doctor's patient was already asleep for surgery, lift up the
sheet, admire the patient's breasts, and continue his conversation without
pause."[604]

Other gynecologists say that the clinical setting is,
"anything but sexy."" During a pelvic," one doctor said in
an interview, "you don't have time to become aroused...." He is
asked, "How does turning off during office hours affect a gynecologist's
sex life? "It's like the chef at a fast-food restaurant who makes the same
hamburger a thousand times a day," he answers. "Then he goes home to
his family and enjoys a warm, delicious meal."[605]

The adrenaline surge is also a
major contributor to the hyperalert symptoms of PTSD:the startle response, insomnia, nightmares,
and so on.If you suffer from PTSD,
situations that remind you of the original traumatic event can trigger an
adrenaline surge.The adrenaline surge
then in turn activates memories and feelings associated with the traumatic
event, leading to extreme distress.You
may become agitated, irritable, or even have rage reactions, increased night
terrors, or flashbacks.Alternatively,
you may have a numbing reaction after exposure to a person, place, or object
reminiscent of the original traumatic situation.Or you may alternate between re-experiencing
the trauma and shutting down.

Since both hyperalertness and
numbing can be painful, you may find yourself avoiding trigger situations –
those that remind you of the original traumatic event.Such avoidance behavior may limit your
opportunities and options.On the other
hand, staying away from or minimizing your contact with situations that trigger
your PTSD symptoms makes perfect sense emotionally.In either case, there may be trigger
situations you cannot or do not wish to avoid because they potentially enrich
your life.The exercises on coping with
triggers in Chapter 5 will provide you with suggestions and guidelines for
managing your reactions and reducing your stress levels in distressing
situations.

When Stress is Prolonged

The adrenals, like the rest of
your body, are not designed to handle prolonged stress.When subjected to repeated trauma or
emergencies, the adrenals can be permanently damaged – leading to
overfunctioning during subsequent stress, which causes the hyperarousal and
numbing phases of PTSD.

Under severe stress, in
addition to massive secretions of adrenaline and noradrenaline, a variety of
neurotransmittors are released.Neurotransmittors are the chemical substances that enable impulses to be
transmitted from one nerve cell to another (Bourne 1990).Among their many functions, neurotransmittors
help regulate the intensity of emotions and moods.

If you were subjected to
repeated or intense trauma or stress, certain of your neurotransmittors may
have been depleted.The lack of these
“buffer” neurotransmittors can lead not only to clinical depression, but to
mood swings, explosive outbursts, overreactions to subsequent stress, and the
startle response.Depletions of some
neurotransmittors can result in overdependence on other people, feelings of I
can’t make it without uou, or its opposite, an unrealistically independent or
counterdependent stance of I don’t need anyone; I can make it on my own.The learned helplessness syndrome is another
possible development.

The Learned Helplessness Syndrome

In a famous series of
experiments conducted by Martin Seligman (1975), animals were subjected to
electric shocks from which they could not escape.No matter what they did, or didn’t do, they
couldn’t stop the pain.At first the
animals fought, tried to get away, and uttered cries of pain or anger.Then they sank into listlessness and
despair.Later on, in a second set of
experiments, the same animals were shocked again – only this time, by pressing
a certain lever or completing some other simple task, they could stop the
electric current.But they made no
effort to do so.

The animals had learned to be helpless.Due to their previous experiences, even when
a means of escape from the pain was provided, these animals were too defeated,
perhaps too affected neurologically, to take the simple action that would end
their suffering.

Excerpt from:

I Can’t Get Over It: A Handbook for
Trauma Survivors 2nd edition., Aphrodite Matsakis, New Harbinger
Publications, 1996

The limbic system of the brain could be called “survival central”.It responds to extreme stress/trauma/threat
by setting the HPA (Hypothalamic-pituitary-adrenal) axis in motion, releasing
hormones that tell the body to prepare for defensive action.The hypothalamus activates the sympathetic
branch (SNS) of the autonomicnervous
system (ANS), provoking it into a state of heightened arousal that readies the
body for fight or flight.As epinephrine
and norepinephrine are released, respiration and heart rate quicken, the skin
pales as the blood flows away from its surface to the muscles, and the body
prepares for quick movement.When
neither fight or flight is perceived as possible, the limbic system commands
the simultaneous heightened arousal
of the parasympathetic branch (PNS) of the ANS, and tonic immobility (sometimes
called “freezing”) – like a mouse going dead(slack) or a frog or bird becoming
paralyzed (stiff) – will result(Gallup & Maser 1977).As mentioned previously, it is not yet known
what is happening in the HPA axis that causes the body to freeze instead of
fight or flee.

In the case of PTSD, cortisol secretion is not adequate to halt the alarm
response.The brain persists in
responding as if under stress/trauma/threat.At this time it is not known which is the first driving factor: a
continued perception of threat in the mind or insufficient cortisol.The result, however, is the same:The limbic system continues to command the
hypothalamus to activate the ANS, persisting in preparing the body for fight/flight
or going dead, even though the actual traumatic event has ended – perhaps years
ago.People with PTSD live with a
chronic state of ANS activation – hyperarousal – in their bodies, leading to
physical symptoms that are the basis of anxiety, panic, weakness, exhaustion,
muscle stiffness, concentration problems, and sleep disturbance.

Medical clinic's sterilization methods prompt hepatitis, HIV warnings

Jason Markusoff, CanWest News Service; Edmonton Journal

Published: Wednesday, March 28, 2007

EDMONTON -- In a disturbing health alert, 261
women in the Lloydminster,
Alta., region are being urged to undergo blood testing for HIV, as well as for
hepatitis B and C, due to concerns over sterilization of medical instruments.

The affected patients of the only obstetrics-gynecology office in Lloydminster, a city
located on the Alberta- Saskatchewan border, have all been contacted, said Dr.
Musbah Abouhamra of the Lloyd Women's Clinic.

Abouhamra said he has assured his patients, even those who do not need to be
tested because of the past problems at the office, that the chances of
"very, very, very very small" that they will get sick, and that
nobody should worry.

"The risk of these infections in this community is way too small,"
Abouhamra said in an interview Tuesday from his office in Lloydminster.

Alberta Health Minister Dave Hancock alerted the public this week about
issues at an unnamed east-central Alberta doctor's office that were in some
ways similar to the recent problems at a hospital two hours away in Vegreville,
Alta. There, auditors had found improperly brushed and sterilized surgical
tools that still had bits of human blood and flesh on them, and the call-backs
began Tuesday for the dozens -- possibly hundreds -- of former hospital
patients who must be screened for what public-health officials deem a
"very low risk" of blood-borne pathogens.

Abouhamra said it was his clinic that the College of Physicians
and Surgeons of Alberta had investigated two years ago for improper
sterilization of medical equipment.

"The method we used in sterilization was different from the Vegreville
case," he said. He would not elaborate on the problems, saying there was
no need to get into scientific details.

He began his practice four years ago, and performs an array of procedures,
including delivering babies.

Officials have said the two-year-old problems have been remedied, and the
doctors are still allowed to operate.

Alberta Health and Saskatchewan's Prairie North Health Region, which
oversees the border city's health system, are managing the patient call-backs,
after being informed about them by the regulatory college only days ago in the
wake of the Vegreville crisis.

Abouhamra said the patients he's discussed the problem with have been very
understanding. "We haven't seen much of a bad reaction."

Elsewhere in Lloydminster,
however, there seemed to be deeply held patient concerns about a health scare
in the city.

Dr. Tom Cavanagh of the Lloydminster Clinic said his office fielded anxious
phone calls from patients Tuesday, after newspaper reports that an unidentified
"Lloydminster
clinic" had sterilization problems that put patients at a small risk of
disease.

Cavanagh questioned why Hancock made public the investigation, which the
college said it kept quiet because of confidentiality laws. "I don't see
that stirring up anxiety in the public is a good thing, and there is a negative
result from doing that," Cavanagh said.

It was only through media leaks and journalistic sleuthing that it became
known that the problem was in Lloydminster,
and that it concerned the city's lone women's-health specialty clinic.

Laurie Blakeman, the opposition Liberals' health clinic, said she also
received phone calls from panicking Lloydminster
residents, unsure if their clinic was affected. "This is a perfect example
of why public disclosure is important," she said.

Michael Neary, butcher and obstetrician

Miss Fitz was a student midwife in Lourdes
hospital while Dr. Neary was the consultant there.

I recall so vividly a day that this man was going to do the ward rounds.
Well in advance, we were sent around to all the women, whose beds formed a
U-shape down the walls and across the bottom. There were probably about 30 or
so in the ward, and we had to pull their nightdresses above their ‘bumps’ to
their chest, and the sheet down to just below. I remember standing in the
doorway and surveying the pink bumps, all sizes and shapes, like so many melons
in a row in a field.

Neary entered the ward, with his coterie of medical and nursing students and
a great silence fell upon us. He made his way from bed to bed, never speaking
except to the Sister, feeling, probing and grunting. About half way down, he
came to the bed of a young mother, who broke the stillness and asked ‘Doctor,
is my baby alright’.

He stopped and stared at her, spoke in the ear of the Sister and walked to
the next bed. Sister turned to the patient and hissed, “You are only a patient,
you never, never address Mr Neary to his face”. I left Drogheda
after 2 months, deciding midwifery was not my bag.

It wasn’t until 1998 that 2 student nurses took the very brave decision to
challenge Neary's behaviour and ask to have his record of caesarian
hysterectomies reviewed, due to what they felt was an abnormally high rate of
such procedures.
http://http://www.irishhealth.com/index.html?level=4&id=5111

Neary was suspended by the Irish Medical Council in 1999, and was struck off in
2003. A Public Enquiry was established by the Minsiter of Health in 2004, and
the Report was published in February of this year (2006). An apology was issued
by the Government in March to the women who were affected, with Bertie Ahern
telling them that he was appalled. The Harding Clark Report into the scandal
also identified that 44 of the 129 relevant patient charts had gone missing,
and the entire issue is being referred to the Gardai.

There are many complex layers of issues in the Neary story. Lack of
accountability and training were certainly 2 of the areas identified in the
report. The idea of other colleagues not finding it strange for such a shocking
level of this procedure being carried out is also one that calls into question
the idea of medical solidarity at all cost. The impact of blowing the whistle
on such a tale is also going to have to be considered seriously by the powers
in Dublin.

But more than anything, it highlights the utter disregard of a surgeon for his
vulnerable female patients. The arrogance and lack of concern for these women,
their lives and their futures make this a disgraceful episode in Irish history.

After his actions caught up with him, insofar as they have, 44 patients’
files (38 of which were Neary’s patients) were removed from the hospital
illegally by a person or persons trying to protect him. Another attack on the
women who were ‘only patients’.

The controversy over the high level of Caesarean hysterectomies
performed by an obstetrician at Our Lady of Lourdes Hospital in Drogheda first came to attention in 1998. It has taken
until now for the Medical Council, which polices doctors’ behaviour, to rule
that consultant obstetrician, Dr Michael Neary be struck off the medical
register for professional misconduct.

Successive Health Ministers must also share the blame for not
introducing, as promised, new laws to allow better monitoring of doctors by the
Medical Council.

Trust in doctors has been lost in Ireland due to the blood infection
scandal, the organ retention controversy and high-profile lawsuits.

The fact is that once a doctor qualifies, there is no formal
mandatory procedure to ensure that he or she remains competent. Currently, the
Medical Council catches bad doctors - after patients have been hurt or have
died. This can not continue to be the case.

The alarm bells in this controversy were first raised at the
hospital in late 1998, not by medical colleagues, but by two student nurses. In
some respects, they risked their future careers by challenging a medical consultant.
A Caesarean hysterectomy is a very rare emergency procedure involving the
removal of the womb and ovaries to stop uncontrolled bleeding. After being
notified of the issues, the Medical Council suspended Dr Neary from the
register in early 1999, pending a formal inquiry by its Fitness to Practise
Committee.

Initial inquiry

Meanwhile, after the complaints were reported to the North Eastern
Health Board, (which had taken over the running of the hospital from the
Medical Missionaries of Mary) an independent review was ordered. It was
conducted by thee members of the Institute of Obstetricians and Gynaecologists
(IoG). While the result of that review in 1999 found that Dr Neary had a high
rate of Caesarean hysterectomies which was ‘clinically unacceptable’ it did
recommend that he be allowed back to work with certain conditions. No patients
were interviewed as part of that inquiry. The inquiry found that Dr Neary
performed close to 40 Caesarean hysterectomies over a six year period.

After this report, the North Eastern Health Board set up a helpline
for those affected and a support group was also set up by women who had been
treated by Dr Neary.

Women spoke of shock and devastation at the news and the fact that
they would never be able to have children after having an unnecessary
hysterectomy. For others it also meant the early onset of the menopause.

In his defence, Dr Neary said that he had been
working hard for many years; his ready availability in the hospital exposed him
to a lot of emergency work; he had little time for postgraduate education and
he undertook work over and above his expected clinical responsibilities.
However, the inquiry by the IoG team had found that he overestimated blood loss
in patients

Medical Council –
internal report critical of its handling of the Neary controversy.

The Medical Council has now ruled that Dr Neary was guilty of
professional misconduct in relation to 10 female patients who had their wombs
removed. It has decided that he be struck off the register. Dr Neary has 21
days in which to appeal this decision to the High Court. If he does appeal, the
case will be reheard in full, but this time in public. The Medical Council inquiry
was held in private.

Medical Council President, Dr Gerry Bury has said that if the
Council has made any mistakes in dealing with the case, it apologises. In fact,
a recent private report, commissioned by the Medical Council, on its handling
of the Neary case, was highly critical of the Council. The report, conducted by
former Attorney General, Harry Whelahan SC, found that some complaints made
against Dr Neary were not acknowledged, at times not recorded and there were
long delays.

Mr Whelahan said that the fragmented way the Neary inquiry was
conducted and the length of time it took had caused a sense of disillusionment.
He has recommended a standard procedure for dealing with future complaints from
patients.

In some respects, the Medical Council has its hands tied under
current legislation and does not have the resources or structures to stop
doctors working if there is a risk to patients.

State - failure to act

This controversy also raises big questions about how the State
ensures that patients are properly protected from doctors who may have lost the
ability to perform to an acceptable standard. Since 1989, the Medical Council
has asked successive Health Ministers to introduce new legislation to give the
Council new powers to act against doctors who place people’s lives or health in
danger. For well over a decade, despite repeated promises, the Department of
Health has failed to produce that vital legislation. Over that time we have
seen the astonishing Dr Harold Shipman affair in Britain, the scandal over the
deaths of children at the Bristol Royal Infirmary and many controversies here
too.

It is time that our Government took the protection of patients
seriously and gave the Medical Council powers to act before more people get
hurt by bad doctors. There is also a need to allow Medical Council inquiries to
be held in public and generally more openness in relation to how inquiries are
proceeding. We need to see more ‘lay’ members on the Fitness to Practise
Committee of the Medical Council and a system that allows speedier inquiries.

Public inquiry

The pressure is also mounting for a public inquiry into the Neary
case and related matters at Our Lady of Lourdes Hospital in Drogheda.
This hospital has been at the centre of several controversies in recent years,
some of which have still to complete their course in the courts and can not be
referred to here for legal reasons. To restore public confidence, the Health
Minister now needs to act on calls for a proper investigation into the unit at Lourdes. He also needs to
meet his Department’s long-standing commitments in relation to new legislation.

With some 60 other cases pending in relation to Caesarean
hysterectomies, this is a controversy that will run for some time. Of concern
is the fact that in around 20 per cent of cases, the medical files relating to
the women have gone missing.

Many questions remain unanswered: why did it take so long for the
difficulties to be spotted and the authorities notified? why were no controls
in place to spot problems in the hospital unit? Why did it take the Medical
Council so long to rule on the matter? So many questions, so much hurt and the
final cost will be very high indeed.

Information about trauma and its consequences plays an important role in recovery. Survivors and their family members who understand trauma are better able to predict when symptoms will occur and learn new, more effective coping skills.

The links below are designed to provide some of the information that can be critical in recovery: 1. Psychological Symptoms After Trauma 2. Acute Stress Disorder 3. Post-Traumatic Stress Disorder 4. What to Expect 5. Managing Sleep Problems After Trauma 6. Managing Flashback ________________________________________1. Psychological Symptoms After Trauma Most of those who are exposed to a potentially traumatic event do not develop significant psychological symptoms and will recover with little difficulty.Below is a list of possible trauma-related symptoms:Initial Crisis Reaction"Fight or flight," physical shock, disorientation, numbness, enhanced psychological/physical abilities, fatigueShort Term ResponseFear/terror, anger, guilt/questions about response, thinking about and/or re-experiencing the event, withdrawal and isolation, sensitivity to triggers, avoidance of reminders, problem concentratingLong Term ResponseWork problems, development of psychological problems, i.e. anxiety, depressive disorders, conflict, physical problems

________________________________________

2. Acute Stress Disorder The Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association, describes psychological disorders. They are used by mental health professionals and others to make diagnostic decisions.A. The person has been exposed to a traumatic event in which both of the following were present:1. The person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others 2. The person's response involved intense fear, helplessness or horror B. Either while experiencing or after the experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:1. A subjective sense of numbing, detachment, or absence of emotional responsiveness) a reduction in awareness of his or her surroundings (e.g., "being in a daze") 2. De-realization 3. Depersonalization 4. Dissociative amnesia (i.e. inability to recall an important aspect of the trauma) C. The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the event.D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g. thoughts, feelings, conversations, activities, places, people).E. Marked symptoms of anxiety or increased arousal (e.g. difficulty sleeping, irritability, poor concentration, hypervigilence, exaggerated startle response, motor restlessness).F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.G. The disturbance lasts for a minimum of two days and a maximum of four weeks and occurs within four weeks of the traumatic event.H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, an is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

— DSM IV, American Psychiatric Association________________________________________3. Posttraumatic Stress Disorder The Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association, describes psychological disorders. They are used by mental health professionals and others to make diagnostic decisions.A. The person has been exposed to a traumatic event in which both of the following were present:1. The person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others 2. The person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed by disorganized or agitated behavior B. The distressing event is persistently re-experienced in at least one of the following ways:1. Recurrent and intrusive distressing recollections of the event including images, thoughts or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed 2. Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content. 3. Acting or feeling as if the event were recurring (includes a sense of reliving the experience, illusions, hallucinations, or dissociative flashback episodes, including those that occur on awakening or when intoxicated. Note: In young children, trauma specific reenactment may occur. 4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble as aspect of the event. 5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble as aspect of the traumatic event. C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness is (not present before the event), as indicated by three (or more) of the following:1. Efforts to avoid thoughts or feelings or conversations associated with the trauma 2. Efforts to avoid activities, places or people that arouse recollections of the trauma 3. Inability to recall an important aspect of the trauma 4. Markedly diminished interest or participation in significant activities 5. Restricted range of affect, e.g., unable to have loving feelings 6. Sense of a foreshortened future, e.g., child does not expect to have a career, marriage, or children, or a long life

D. Persistent symptoms of increased arousal (not present before the event) as indicated by two (or more) of the following:1. Difficulty falling or staying asleep 2. Irritability or outbursts of anger 3. Difficulty concentrating 4. Hyper vigilance 5. Exaggerated startle response E. Duration of the disturbance (symptoms in Criteria B, C, D) is more than one month.F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.— DSM IV, American Psychiatric Association________________________________________4. What to Expect Immediate emotional changes are normal. For most people, they will fade with time. About 25% of those exposed to trauma will experience longer-term problems.Survivors who have experienced other traumatic events may be more or less likely to have further difficulties.Survivors with difficulties may alternate between periods when they are anxious and re-experience the incident and times when they are depressed and withdraw from family, friends and activities. These changes are to be expected.Situations, which include strong reminders of the traumatic incident, may make post trauma consequences worse.Anniversaries of the event may cause memories and worsen post trauma consequences.Families and friends become co-survivors and often experience post trauma consequences of their own.Survivors who recover most effectively are those who take specific actions to manage their consequences.________________________________________

5. Managing Sleep Problems After Trauma There is no substitute for sleep. Sleep provides important physical and psychological benefits and provides the opportunity to replenish important brain chemicals. People need a wide variation of sleep, anywhere from one to ten hours a day. The important thing is that you receive enough sleep to feel relaxed and alert.Sleep problems are common among people exposed to traumatic events. You may find that your usual methods of falling asleep no long work or that you wake up during the evening or early in the morning. Nightmares and terrors may also occur.Practicing good sleep hygiene may be of some assistance. Consider some of the following tips adapted from an article by Connie Saindon, a psychotherapist in California.1. No reading or watching TV in bed. These are wake activities. Your bed should be used for sleep activities. 2. Go to bed when you're sleep-tired, not when it is time to go to bed by habit, 3. Wind down during the second half of the evening before bedtime. 90 minutes before bed, don't get involved in any kind of anxiety provoking thoughts or activities. 4. Do some breathing exercises or try to relax major muscles groups starting with the toes and ending with your forehead. 5. If you don't fall asleep in 15 to 20 minutes, get up and do something relaxing. 6. Have your room cool rather than warm. 7. Don't count sheep, counting is stimulating. 8. Exercise in the afternoon or early evening, but no later than 3 hours before bedtime. 9. Don't overeat and eat 2-3 hours before bedtime. 10. Don't nap during the day. 11. If you awake during the middle of the night and can't get to sleep within 30 minutes, get up and do something else. 12. Have no coffee, alcohol or cigarettes two to three hours before bedtime. 13. Schedule 30 minutes of writing about your concerns and hopes each day to reduce anxiety. 14. Listen to calm music or a self-hypnosis tape for sleep ________________________________________6. Managing Flashbacks Only a few people experience flashbacks after exposure to a traumatic event. The more vivid the sights, sounds and smells of the incident, the more likely you will be to develop them.Here are some suggestions that you may find helpful in managing flashbacks.You are likely to experience more flashbacks if you believe that you are "going crazy" or "losing it". Flashbacks will likely fade as you remind yourself that they are okay.Flashbacks may follow a "trigger". A trigger is an event or thought which reminds you of the traumatic incident. It is also possible that there will be no trigger. These flashbacks seem scarier because they are less easily explained.Learn how to talk to yourself. When you have a flashback, remind yourself of the facts. Talk to yourself by saying something like:I’m okay. I just had a really scary flashback," or "Flashbacks are normal after what I lived through."Learn how to talk to others. Tell them in detail about what you have experienced. Ask them if you can talk to them again when you have other post trauma consequences.If flashbacks interfere with your work or at home, consider seeking post-trauma counseling.

There are common effects or conditions that may occur following a traumatic event. Sometimes these responses can be delayed, for months or even years after the event. Often people do not initially associate their symptoms with the precipitating trauma. The following are symptoms that may result from a more commonplace, unresolved trauma, especially if there were earlier, overwhelming life experiences:

The following additional symptoms of emotional trauma are commonly associated with a severe precipitating event, such as a natural disaster, exposure to war, rape, assault, violent crime, major car or airplane crashes, or child abuse. Extreme symptoms can also occur as a delayed reaction to the traumatic event.

Even when unrecognized, emotional trauma can create lasting difficulties in an individual's life. One way to determine whether an emotional or psychological trauma has occurred, perhaps even early in life before language or conscious awareness were in place, is to look at the kinds of recurring problems one might be experiencing. These can serve as clues to an earlier situation that caused a dysregulation in the structure or function of the brain. Common personal and behavioral effects of emotional trauma:• substance abuse • compulsive behavior patterns • self-destructive and impulsive behavior • uncontrollable reactive thoughts • inability to make healthy professional or lifestyle choices • dissociative symptoms ("splitting off" parts of the self) • feelings of ineffectiveness, shame, despair, hopelessness • feeling permanently damaged • a loss of previously sustained beliefs Common effects of emotional trauma on interpersonal relationships:• inability to maintain close relationships or choose appropriate friends and mates • sexual problems • hostility • arguments with family members, employers or co-workers • social withdrawal • feeling constantly threatened

What if symptoms don't go away, or appear at a later time?Over time, even without professional treatment, symptoms of an emotional trauma generally subside, and normal daily functioning gradually returns. However, even after time has passed, sometimes the symptoms don't go away. Or they may appear to be gone, but surface again in another stressful situation. When a person's daily life functioning or life choices continue to be affected, a post-traumatic stress disorder may be the problem, requiring professional assistance.

How is emotional trauma treated?Traditional approaches to treating emotional trauma include:• talk therapies (working out the feelings associated with the trauma)• Cognitive-Behavioral Therapy (CBT) involves changing one's thoughts and actions, and includes systematic desensitization to reduce reactivity to a traumatic stressor • relaxation/stress reduction techniques, such as biofeedback and breathwork• hypnosis to deal with reactions often below the level of conscious awareness

There are also several recent developments in the treatment of emotional trauma. Depending on the nature of the trauma and the age or state of development at which it occurred, these somatic (body) psychotherapies might even be more effective than traditional therapies. Some of the new therapies include: • EMDR (Eye Movement Desensitization and Reprogramming) • Somatic Experiencing • Hakomi • Integrative Body Psychotherapy

Improving intimate love relationships — especially when trauma occurs early in life — is another means of healing disabilities caused by emotional trauma.